Don’t think that being unable to control your mouth and inheritance is the root cause of diabetes . Chronic liver diseases such as cirrhosis are also associated with diabetes, which is often underestimated. Maybe everyone will have questions, how does liver problems cause diabetes? How should it be treated? Let's continue to look...
patients with cirrhosis
are more susceptible to diabetes
diabetes secondary to chronic liver parenchymal damage is collectively called hepatogenic diabetes (HD). Patients with chronic liver disease, especially cirrhosis, are more likely to develop hepatogenic diabetes, with a prevalence of 35% to 71%, which is much higher than the general population.
How does the liver affect blood sugar? The liver is one of the main organs involved in glucose homeostasis and plays an important role in energy balance and glucose metabolism. When chronic liver disease progresses to terminal liver disease, the body's energy metabolism and sugar metabolism are often abnormal due to impaired insulin signal transduction and changes in glucose transport.
liver disease is closely related to sugar metabolism disorder and is mutually causal. On the one hand, diabetics have an increased risk of dying from chronic liver disease. On the other hand, the severity of diabetes is related to the degree of liver damage, and diabetes will increase the incidence of chronic liver disease complications such as hepatocellular carcinoma, hepatic encephalopathy , gastrointestinal bleeding, spontaneous bacterial peritonitis, and at the same time reduce the quality of life and survival rate of patients with liver disease.
symptoms are atypical. Beware that hypoglycemia
has hidden onset of HD compared with primary type 2 diabetes, lacks typical "three more and one less" diabetes symptoms, has a low correlation with weight, has a family history of diabetes, and has a lower incidence of hyperlipidemia, cardiovascular disease and retinal diseases.
Hepatogenic diabetes is mostly manifested as fasting blood sugar is normal or slightly higher, blood sugar is significantly increased after meals, and hypoglycemia is prone to occur. Because most patients with liver disease have malnutrition, most patients are already in the end stage of liver disease when they diagnose hepatogenic diabetes. These patients have an increased risk of hypoglycemia, which brings difficulties to treatment.
Therefore, patients with severe liver disease must pay attention to monitoring blood sugar, deal with hypoglycemia in a timely manner, strengthen energy support treatment, and add meals before going to bed to prevent hypoglycemia at night and on an empty stomach.
Diet + exercise is important for patients with liver disease
Most hypoglycemic drugs will increase the risk of cirrhosis complications. Therefore, patients with chronic liver disease should closely monitor their blood sugar, pay attention to changes in the condition of hepatogenic diabetes, seek medical treatment in a timely manner, and apply individualized plans to control sugar according to the recommendations of specialist .
The treatment principle of hepatogenic diabetes is: treat basic liver disease, actively control hyperglycemia to prevent hypoglycemia. Among them, dietary treatment is very important for hepatogenic diabetes.
carbohydrate should account for 55%-65% of the total calories, 20%-30% of fat are mainly unsaturated fatty acids, 310%-15% of protein , 40-60g of dietary fiber per day, 3300mg of cholesterol ,300mg of salt. Based on a scientific diet, moderate exercise should be based on appropriate amounts of daily life activities, and the time should not be too long. Generally, it starts 30 minutes after the meal and keeps relatively quiet after 2 hours to avoid hypoglycemia before the next meal.
can use insulin. Oral hypoglycemia-induced drugs are as directed by doctors. When taking medication, patients with hepatogenic diabetes should choose oral drugs that do not increase the burden on the liver, and oral drugs that are metabolized by the liver as much as possible; at the same time, it is recommended to use insulin. Ideal insulin treatment should be close to physiological insulin secretion modes, such as basal insulin combined with oral medications, or basal insulin combined with mealtime insulin. Specific insulin application programs require consultation with a specialist.
oral antidiabetic drugs are mostly metabolized by liver and kidney, and hepatogenic diabetes usually occurs after cirrhosis. Therefore, HD patients should consult a specialist and choose suitable oral antidiabetic drugs. The following are six commonly used oral hypoglycemic drugs:
metformin is a basic drug in the combination of first-line drugs and drugs for controlling hyperglycemia. It has a therapeutic effect on fasting blood sugar and postprandial blood sugar. The main side effect is gastrointestinal reaction.
Insulin secretagogue Commonly used drugs include Glicit, Glimepide, reglinide , etc. The main pharmacological effect is to stimulate pancreatic β cells to secrete insulin and reduce glycemic risk, which is higher.
thiazolidinediones Commonly used drugs include pioglitazone, rosiglitazone, etc., which can increase the sensitivity of tissue cells to insulin.
α glycosidase inhibitor Commonly used drugs include acarbose , voglipose , etc. It can slow down the rate of digestion of carbohydrates into glucose in the intestines and reduce postprandial blood sugar.
α and β dual regulator drugs One of them is commonly used drugs for dipeptidyl peptidase 4 inhibitors, such as sitagliptin, agliptin , linagliptin, etc. The other type is intestinal receptor agonists, and commonly used drugs include Smegglutide and Dulagolide.
sodium-glucose cotransporter 2 inhibitor Commonly used drugs include engagliflozin and dapagliflozin .
text/Wei Linlin (Beijing You'an Hospital)
